Research Case Studies

GASTROSAM Trial

The GASTROSAM trial found that intravenous rehydration was as safe as the standard oral approach in children with severe acute malnutrition (SAM), challenging long-held assumptions about the risk of IV rehydration in severely malnourished children.

The trial also demonstrated that oral rehydration with standard oral rehydration salts (ORS) was safer than the low sodium (ReSoMAL) ORS.

The new evidence provided by GASTROSAM is now under review by Médecins Sans Frontières and World Health Organization and will likely lead to changes in global treatment guidelines for SAM in 2026. 

The REACH Trial: Improving treatment for sickle cell anaemia

The REACH (Realising Effectiveness Across Continents with Hydroxyurea) trial is a multicentre Phase II trial that is investigating the utility hydroxyurea for the treatment of children with sickle cell anaemia in Africa. Sickle cell anaemia is the commonest severe genetic condition worldwide, and the majority of children born with the disease live in Africa. Hydroxyurea is tried and tested as an effective treatment in high income countries where treatment is normally monitored very closely because it causes mild immunosuppression when used at therapeutic doses. Hydroxyurea has not been used extensively in Africa because of anxiety that the drug might cause unwanted side effects in settings where the burden of infections is high and where resources for monitoring are few. 

The REACH trial is addressing the feasibility and safety of using hydroxyurea in more than 600 children across four sites in Kenya, Uganda, DRC and Angola. So far, the trial has found that the drug is extremely effective in preventing a broad range of complications and is not associated with any serious side effects. 

The trial has been extremely influential in promoting the use of hydroxyurea in Africa where it has now been added to treatment guidelines in a number of countries and WHO are also considering a new guideline too. 

Results from REACH have been published in a number of prestigious journals including the New England Journal of Medicine, Lancet Haematology and Blood.

Research Case Studies

The MIMBLE: Legume-based feeds for severe malnutrition

The MIMBLE (Modifying Intestinal MicroBiome in severe Malnutrition with Legume-based feeds) project has looked at whether locally produced feeds containing fibres from beans, soy and sweet potatoes, can help restore African children with severe ccute malnultrition to health by providing food for beneficial gut bacteria.  

During the project, our research group developed and tested legume-based formulae, which provides similar nutritional value (protein and energy) and uses products which are grown locally, aimed at optimising gut function by ‘feeding the microbiome’. Two trials were conducted in critically sick children with severe malnutrition and both provided early indications of improved gut health and better clinical outcomes.

 

The TRACT Trial: Improving treatment for children in Africa

Clinical trials led by one of our researchers could change the way children with severe anaemia are treated in Africa. The TRACT trial looked at different blood transfusion strategies for the condition, which is common and life-threatening for children in sub-Saharan Africa. 

The trials showed that giving more blood to some children could halve the number of deaths from the condition. The results also showed that “watch and wait” was a safe strategy for some children with severe anaemia. These findings could help save lives and crucial resources.

The FEAST Trial: Children’s medicine re-evaluated

The FEAST (Fluid Expansion as Supportive Therapy) trial tested a treatment used worldwide for children in Africa who were suffering from fever and shock caused by malaria, sepsis, and other infections. Standard care in such cases has long involved treatment called "fluid resuscitation", which involves giving large amounts of fluids directly into the veins quickly within the first hour of hospital admission. 

The trial examined this approach in over 3,000 children across six hospitals in Tanzania, Uganda, and Kenya. Researchers compared the effects of rapid fluid administration with slower fluid administration to determine which approach improved survival.

The study found that children who received fluids more slowly had better outcomes, with a 48-hour survival rate of over 92%, compared with 89% for those given rapid boluses. In other words, rapid fluid resuscitation led to three additional deaths for every 100 children treated.

The FEAST trial won the prestigious 2011 BMJ Research Paper of the Year award.